Abstract Spindle cell rhabdomyosarcoma (RMS), a variant of embryonal RMS, is a rare tumour, especially in adults. Imaging techniques are used to evaluate the extent of the tumour whereas a biopsy is ...required to make the final diagnosis. In this article we describe a case of mandibular Spindle cell RMS in a previously irradiated field in a 56-year-old male, and discuss the clinicopathologic and imaging findings. Although the aetiology is still unclear, this case suggests that previous radiation therapy can be a causal factor.
Intake of a high‐fat meal induces a systemic inflammatory response in the postprandial which is augmented in obese subjects. However, the underlying mechanisms of this response have not been fully ...elucidated. We aimed to assess the effect of gut microbiota modulation on postprandial inflammatory response in lean and obese subjects. Ten lean and ten obese subjects with metabolic syndrome received oral vancomycin 500 mg four times per day for 7 days. Oral high‐fat meal tests (50 g fat/m2 body surface area) were performed before and after vancomycin intervention. Gut microbiota composition, leukocyte counts, plasma lipopolysaccharides (LPS), LPS‐binding protein (LBP), IL‐6 and MCP‐1 concentrations and monocyte CCR2 and cytokine expression were determined before and after the high‐fat meal. Oral vancomycin treatment resulted in profound changes in gut microbiota composition and significantly decreased bacterial diversity in both groups (phylogenetic diversity pre‐ versus post‐intervention: lean, 56.9 ± 7.8 vs. 21.4 ± 6.6, P < 0.001; obese, 53.9 ± 7.8 vs. 21.0 ± 5.9, P < 0.001). After intervention, fasting plasma LPS significantly increased (lean, median IQR 0.81 0.63–1.45 EU/mL vs. 2.23 1.33–3.83 EU/mL, P = 0.017; obese, median IQR 0.76 0.45–1.03 EU/mL vs. 1.44 1.11–4.24, P = 0.014). However, postprandial increases in leukocytes and plasma LPS were unaffected by vancomycin in both groups. Moreover, we found no changes in plasma LBP, IL‐6 and MCP‐1 or in monocyte CCR2 expression. Despite major vancomycin‐induced disruption of the gut microbiota and increased fasting plasma LPS, the postprandial inflammatory phenotype in lean and obese subjects was unaffected in this study.
Translocation of intestinal bacteria into the blood is implicated in the systemic inflammatory response that occurs after a high fat meal. We showed that after gut microbiota manipulation with vancomycin, the postprandial inflammatory phenotype in lean and obese subjects is unaffected, despite major vancomycin‐induced disruption of the gut microbiota and increased fasting plasma LPS. This suggests that bacterial translocation may not play a large role in postprandial inflammation.
Quality measures for colonoscopy are operator dependent and vary. It is unclear whether quality measures change over time. In this study, time-dependent variation in colonoscopy performance was ...examined in a gastroenterology practice.
Colonoscopy and histopathology records that were collected at three hospitals (one university and two non-university hospitals) over three time periods (2007, 2010, and 2013) were reviewed. Data from colonoscopists performing at least 100 procedures per year were analyzed. Inter-colonoscopist variation in performance (i. e. adjusted cecal intubation rate aCIR, adenoma detection rate ADR, advanced ADR, mean adenomas per procedure MAP, proximal ADR, nonpolypoid ADR, and serrated polyp detection rate) were examined using coefficients of variation. Logistic regression analyses were also performed, adjusting for covariates.
A total of 23 colonoscopists performing 6400 procedures were included. Overall, the mean aCIR, ADR, MAP, and proximal ADR improved significantly over time, from 91.9 %, 22.5 %, 0.37, and 10.2 % in 2007 to 95.3 %, 25.8 %, 0.45, and 13.4 %, respectively, in 2013 (P < 0.05). The inter-colonoscopist variation in ADR decreased from 37 % in 2007 to 15 % in 2013 (P < 0.05). In the non-university hospitals, mean values for quality measures increased significantly over time, whereas they remained stable in the university hospital.
Variability in performance among colonoscopists decreased significantly within the gastroenterology clinical practice. Core quality measures improved over time, mainly through improvement of the lower performers. Measurement of inter-colonoscopist variation in performance helps to identify factors that stimulate or hinder performance, and forms the basis for interventions.
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